Contraindicated Drugs

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The medications listed below are potentially toxic to CMT patients. Vincristine has been proven hazardous and should be avoided by all CMT patients, including those with no symptoms. The remainder of the medications listed below present varying degrees of potential risk for worsening CMT neuropathy. Before taking any medication or changing medication, all CMT patients should make sure the treating physician is fully aware of their medical condition. (Ed. note: See here for a few first-hand accounts from people with CMT using these medications.)

Definite High Risk (including asymptomatic CMT)

• Vinca alkaloids (Vincristine/Vinblastine) †

Moderate to Significant Risk

• Amiodarone (Cordarone)
• Bortezomib (Velcade)
• Cisplatin & Oxaliplatin
• Colchicine (extended use)
• Dapsone
• Didanosine (ddI, Videx)
• Dichloroacetate
• Disulfiram (Antabuse)
• Gold salts
• Leflunomide (Arava)
• Metronidazole/Misonidazole (extended use)
• Nitrofurantoin (Macrodantin, Furadantin, Macrobid)
• Nitrous oxide (inhalation abuse or Vitamin B12 deficiency) ‡
• Perhexiline (not used in U.S.)
• Pyridoxine (mega dose of Vitamin B6)
• Stavudine (d4T, Zerit)
• Suramin
• Taxols (paclitaxel, docetaxel) †
• Thalidomide
• Zalcitabine (ddC, Hivid)

Uncertain or Minor Risk

• 5-Fluoracil
• Adriamycin † ‡
• Almitrine (not in U.S.)
• Chloroquine
• Cytarabine (high dose)
• Ethambutol
• Etoposide (VP-16)
• Gemcitabine
• Griseofulvin
• Hexamethylmelamine
• Hydralazine
• Ifosphamide Infliximab
• Isoniazid (INH)
• Mefloquine Penicillamine
• Phenytoin (Dilantin)
• Podophyllin resin
• Sertraline (Zoloft)
• Statins
• Tacrolimus (FK506, ProGraf)
• Zimeldine (not in U.S.)
• α-Interferon

Negligible or Doubtful Risk

• Allopurinol
• Amitriptyline
• Chloramphenicol
• Chlorprothixene
• Cimetidine
• Clioquinil
• Clofibrate
• Cyclosporin A
• Enalapri
• Fluoroquinolones
• Gluthethimide
• Lithium ‡
• Phenelzine
• Propafenone
• Sulfonamides
• Sulphasalzine

Drug Interaction Warning

The November/December 1995 NAMI Advocate warned of a potentially fatal drug interaction. It involves selective serotonin reuptake inhibitor antidepressants such as Prozac, Zoloft, Paxil and Luvox. Apparently, a drug interaction between these antidepressants and dextromethorphan and/or pseudoephedrine, found in over-the-counter cold remedies, can cause excessive serotonergic activity. Signs of this "serotonin syndrome" include changes in mental status, hypertension, restlessness, myoclonus (sudden muscle contraction), hyperreflexia (accentuated reflexes), diaphoresis (profuse perspiration), shivering and tremor.

List prepared by:
Charcot-Marie-Tooth Association
2700 Chestnut Street
Chester, PA 19013
Tel: 800-606-2682
Fax: 610-499-9267
www.charcot-marie-tooth.org
email: CMTAssoc@aol.com

Other medications & chemicals that may have a toxic effect on peripheral nerves:

• Alcohol
• Glues & solvents

Additional Warnings

It is prudent for CMT patients to avoid these medications whenever possible. You should ask your pharmacist to look up any medication that is prescribed for you to see if there may be toxic effects on nerves. There are almost always alternatives.

From Linda Crabtree: In a followup article on drug types that can cause weakness in CMT patients, Dr. Parry mentioned Lipitor, which so many people take for cholesterol problems, as being one of the drugs that can cause muscle damage, although the effect is not on the nerve itself. Amitriptyline is also another drug that can cause fatigue by acting on the central nervous system. It really pays to do your homework when it comes to drugs. So many of us have adverse reactions to drugs that people who don't have CMT can take easily. Your doctor should be looking them up for you before he prescribes them. Don't be afraid to ask. It's your money and your body!

† MDA has this to say regarding cancer drugs and CMT: This is a difficult question because Vincristine for example, has been associated with exacerbation of CMT, and Taxol may have this potential also, although the side effects from Taxol are often sensory and not motor, thereby not necessarily increasing weakness. To the best of my knowledge, Adriamycin has only been associated with nerve damage in very high doses in rats or mice. Whether Adriamycin even belongs on the list is questionable in my opinion. I am also in agreement with you that your life comes first and in the end, treating the malignancy is the bottom line.

‡ There are many other medications and chemicals that may have a toxic effect on peripheral nerves. However, there is no evidence that they can cause neuropathy in humans or that they can exacerbate neuropathy in CMT patients. These include: Adriamycin (used in cancer treatment), Lithium (used in psychiatric illness and occasionally in headache relief), Nitrous oxide (used as an anesthetic), Penicillamine (used in rheumatoid arthritis) and many others.